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Psychotherapy and change in mental health-related work disability: a prospective Finnish population-level register-based study with a quasi-experimental design
  1. Johanna Kausto1,
  2. Kia Gluschkoff1,2,
  3. Jarno Turunen1,
  4. Sanna Selinheimo1,
  5. Laura Peutere3,
  6. Ari Väänänen1
  1. 1 Finnish Institute of Occupational Health, Helsinki, Finland
  2. 2 Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
  3. 3 School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
  1. Correspondence to Dr Johanna Kausto, Finnish Institute of Occupational Health, P.O Box 40,FI-00032 TYÖTERVEYSLAITOS, Finland; johanna.kausto{at}ttl.fi

Abstract

Background Mental disorders are a major cause of work disability among the working-age population. Psychotherapy has shown to be an effective treatment for mental disorders, but the evidence is mainly based on small-scale randomised trials with relatively short follow-ups. We used population-based register data to examine the association between statutory rehabilitative psychotherapy and change in depression or anxiety-related work disability.

Methods We drew a nationally representative sample of the working-age population (aged 18–55 in 2010). The study group comprised all those who started rehabilitative psychotherapy in 2011–2014. A total of 10 436 participants who were followed from 3 years prior to 4 years after the onset of rehabilitative psychotherapy. This resulted in 83 488 observations. The annual total number of mental health-related work disability months (0 to 12) was calculated from the total number of annual compensated sickness absence and disability pension days. A quasi-experimental interrupted time series analysis was applied.

Results The onset of rehabilitative psychotherapy marked a decline in work disability in comparison to the counterfactual trend. Specifically, a 20% decrease in the level (incidence rate ratio, IRR 0.80; 95% CI 0.76 to 0.85) and a 48% decrease in the slope (IRR 0.52; 95% CI 0.50 to 0.54) of work disability were detected in comparison to the counterfactual scenario. No significant gender differences were observed. The decline in work disability was the steepest in the oldest age group.

Conclusions This study suggests that statutory psychotherapy may decrease work disability at the population level. However, further evidence of causal inference and the potential heterogeneity of the association is required.

  • MENTAL HEALTH
  • PUBLIC HEALTH
  • SICK LEAVE
  • RECORD LINKAGE

Data availability statement

No data are available. No additional data are available because of Finnish legislation. Only researchers with the permission of the Finnish Social and Health Data Permit Authority and Statistics Finland have access to the analysed data.

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This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Data availability statement

No data are available. No additional data are available because of Finnish legislation. Only researchers with the permission of the Finnish Social and Health Data Permit Authority and Statistics Finland have access to the analysed data.

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Footnotes

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  • Contributors Conceptualisation and methodology: JK, AV, KG, JT and SS; writing original draft preparation: JK; writing review and editing: JK, AV, KG, SS, JT and LP. All authors have read and agreed to the published version of the manuscript. Guarantor: JK

  • Funding This work was supported by the Social Insurance Institution of Finland (grant number 18/26/2020).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.